ABSTRACT
The achilles tendon plays a crucial role in the bipedal human beings. Injury to achilles tendon causes great difficulty in walking and running. This study aims to present the various causes , various treatment modalities and the functional outcome of tendo Achilles injuries. This is a retrospective study of 25 patients of with Tendo Achilles injury who presented at our department between July 2015 to December 2018.Patient age , cause of Tendo Achilles injury associated skin and soft tissue defect, tendon defect, various modalities of treatment and functional outcome were reviewed. A total of 23 men and two women with a mean follow up period of 6months to 15months were included. The most common cause of tendo Achilles injury was due to slipping of foot in an Indian closet .
ABSTRACT
Objective To investigate the clinical effect of thin-layer free anterolateral thigh flap with iliotibial tract for reconstruction of heel soft tissue and Achilles tendon defect.Methods From January,2017 to December,2017,11 cases of heel soft tissue and Achilles tendon defect were repaired by thin-layer free anterolateral thigh flap with iliotibial tract.There were 5 cases with tibia/fibula fracture,3 cases with ankle fracture and 1 case with calcaneal fracture.The area of soft tissue defect was 6.5 cm×10.0 cm-8.0 cm×13.0 cm,and the length of Achilles tendon defect was 5.5-11.5 cm.All wounds were treated with debridement and negative pressure sealing drainage technique at first stage.After 6 days,the soft tissue defect around posterior calcaneal region combined with Achilles tendon defect were repaired by the thin-layer free anterolateral thigh flap with iliotibial tract.Reasonable rehabilitation training was established after operation.Results The flaps survived in 11 cases and the donor region healed in one stage.The patients were followed-up for 8 to 20 (mean,15.74) months by outpatient review,calling or WeChat.Slightly bloated in appearance in 2 cases,and were thinned by orthopedic operation 1 year later.The other flaps were well shaped and moderately thick.At the last follow-up,the flaps were soft in texture and elastic.The sensory recovery of the flap was good,and the two-point discriminant perception in the posterior region of the heel was 3.0-5.0(mean,4.11) mm.Thompson's sign was negative,double or one-foot heel lift test was negative,and there was no recurrence of Achilles tendon rupture or skin ulceration in the heel region.The range of motion (ROM) of affected side was (23.1 1±1.17)°of extension and (43.67±1.06)°of flexion,and the ROM of normal side was (23.79±1.03)°of extension and (44.03±0.94)°of flexion.There was no statistical difference between them (P＞0.05).Postoperative follow-up was conducted according to the Thermann's function evaluation system,the evaluated result was excellent in 8 cases,good in 2 cases,and receivability in 1 case.Conclusion It is a reliable and effective method to repair heel soft tissue and Achilles tendon defect by thin-layer free anterolateral thigh flap with iliotibial tract.And this method can better restore foot ankle shape and function.
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Objective To explore the efficacy of peroneus brevis tendon transfer and peroneal tendofascial flap for repairing achilles tendon and overlying skin defect.Methods From April,2004 to May,2015,5 cases of achilles tendon and overlying skin defect were treated with peroneus brevis tendon transfer and peroneal tendofascial flap.In these cases,the length of the achilles tendon defect was from 3.0 cm to 8.0 cm,and the size of skin defect ranged from 2.0 cm × 3.0 cm to 3.0 cm × 5.0 cm.Using peroneus brevis tendon to reconstruct achilles tendon defect,and covered with peroneal tendofascial flap,and then skin graft.One of them combined with the gastrocnemius tendon V-Y advancement to promote the reconstruction of achilles tendon longer defect.The patients were followed-up regularly,and evaluated by the American Society of Ankle Arrhythmia (AOFAS) ankle-hindfoot scoring system.ResultsAll operations were successful and the grafted skin survived.All cases were followed-up from 6 months to 10 years with an average of 5.2 years.At the time of last followed-up,all wounds healed well without re-infection and ulceration.Not foot varus deformity and the strongth was back to the level before the injury.AOFAS ankle-hindfoot score was increased from (50.44 ± 12.05)(preoperative) to (90.02 ± 6.55)(the last follow-up) (P＜0.05).Conclusion There were some advantages in the method of the treatment of achilles tendon and overlying skin defect by using peroneus brevis tendon transfer and peroneal tendofascial flap,such as easy to cut,small damage to the donor area,and no significant deformity to the receptor area,etc.It is a good way to repair achilles tendon and overlying skin defects.
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Objective To provide a clinical anatomic basis for the bi-pedicled gastrocnemius myocuta- neous flap which is to be used to repair defects of the Achilles tendon and posterior skin of the ankle.Methods In anatomic study,out of 30 cadaver specimens,bi-pedicled V-Y gastrocnemius myoeutaneous flaps were harvested to measure the downward sliding lengths of the flap when the knee was at flexion of different degrees.In clinic,12 patients with the Achilles tendon and posterior ankle skin defects were repaired with the bi-pedicled gastrocnemius myocutaneous flaps.The areas of composite defects ranged from 10 cm?6 cm to 6 cm?4 cm.They were followed up for four months to 12 years.Results The maximal sliding length of the flap reached (9.2?0.9)cm when the knee was at flexion of 90?.All the clinical flaps survived and ambulation of the patients recovered.The dorsiflexion and plantarflexion of the ankles reached 11.0??1.4?and 35.0??4.6?respectively.Conclusion This flap is suitable for one-stage repair of composite Achilles tendon defects.
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Objective To introduce a new surgical method of reconstructing A ch illes tendon by transfer of the soleus tendon flap. Methods The method was desig ned on the basis of the anatomical characteristics of the superficial muscles as sociated with Achilles tendon. It was applied to treat 12 patients with Achilles tendon defects. These patients were followed up for 0.5 to 6 years (average 39 months). Results The curative effect of the method were assessed according to Ar ner-Lindholms evaluation criteria. 9 cases were rated as excellent, 2 fine an d 1 poor, with the total excellent and fine rate being 92%. Conclusions ①Misdi agnosis and improper initial treatment are the major causes of Achilles tendon d efects. ②Systematic training after operation is very important for good curativ e effects. ③The method mentioned above brings about less trauma, less negative effects on blood supply to Achilles tendon, and good healing after operation.
ABSTRACT
Open defect of the Achilles tendon with loss of overlying skin is very difficult to treat. This condition poses problems of combating infection, providing soft-tissue cover and bridging the gap in the tendon. This has been generally managed in multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by the flap. The tendon itself is reconstructed later by a conventional technique. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable one-stage procedure, using a lateral supramalleolar island flap, a fascia lata autograft and a peroneus brevis tendon transfer, which helps tendon units bridge the gap in the Achilles tendon, and thin and mobile skin to cover the defect in the skin. Our patient showed good result, so we report this case with a review of the literature.